The majority of fellows’ clinical experience is provided at the Mount Sinai Children’s Heart Center and Mount Sinai Kravis Children’s Hospital. You will rotate through each of the subspecialties below:

Pediatric Cardiothoracic Intensive Care (PCIC) Rotation
The PCIC rotation introduces fellows to caring for pediatric cardiac patients postoperatively, as well as to the role of the pediatric cardiologist intraoperatively. As a fellow, you’ll learn the pathophysiology of cardiac lesions as well as management of the various cardiac lesions both pre- and post-operatively.

In addition to evaluating and caring for patients, fellows have opportunities to perform certain subspecialty procedures during this rotation. These procedures include cardioversion with adenosine, overdrive pacing, and direct cardioversion and testing of pacing wires. Fellows also learn about cardiopulmonary resuscitation of postoperative patients, management of extracorporeal membrane oxygenation (ECMO), and mechanical assist devices for patients being bridged to transplant. The fellow is responsible for all consults requested within the Pediatric Intensive Care Unit (PICU) and Pediatric Cardiac Intensive Care Unit (PCICU).

Fellows are also encouraged to spend a portion of the PCIC rotation in the operating suites, observing pediatric cardiothoracic surgical procedures. This gives fellows the opportunity to learn about congenital heart defects in vivo, anesthetic approaches to cardiac surgery in patients with congenital heart disease, and various aspects of cardiopulmonary bypass.

Noninvasive Imaging Rotation
During the noninvasive imaging rotation, fellows primarily work on transthoracic echocardiography in the Pediatric Echocardiography Laboratory. There is an extensive, hands-on course for fellows that starts the first two weeks of July. This allows fellows to get introduced to concepts of imaging and develop familiarity with imaging equipment. Skills are taught using a one-on-one interactive curriculum. Fellows are encouraged to do hands-on imaging under direct supervision initially and perform complete echocardiograms independently after six months. The goal is for all fellows to be able to independently identify, diagnose, and come up with a management plan following imaging of normal, simple, and complex congenital heart and acquired congenital heart disease. After the second year, fellows are encouraged to learn transesophageal echocardiography as well as fetal echocardiography. In the third year, fellows are encouraged to participate in cardiac CT and MRI procedures.

Inpatient Rotation
Our inpatient service cares for newborns, infants, children, and adults hospitalized with congenital heart or acquired heart disease. The inpatient service team includes a pediatric cardiology attending, a pediatric cardiology fellow, pediatric residents, and fourth-year medical students rotating on the service for one month. The team is responsible for pediatric patients with cardiac problems hospitalized in the neonatal intensive care unit (NICU), pediatric emergency room, newborn nurseries, and pediatric inpatient floors.

The inpatient service team makes daily teaching rounds, during which all patients are examined, and all relevant laboratory data is reviewed. As you progress through your training, you will receive greater responsibility in leading the rounds and making clinical decisions. Fellows are also responsible for pediatric cardiology consultations in all areas of the hospital except for the PICU and PCICU.

Outpatient Rotation
Fellows are required to attend one of two ambulatory half-day pediatric cardiology clinics held weekly at The Mount Sinai Hospital. These clinics include referral and follow-up service for all types of heart problems, including congenital and acquired heart disease. Each clinic is supervised by a pediatric cardiology faculty member who reviews all findings with the fellow. Emphasis is placed on developing detailed history taking for outpatient cardiac problems, as well as physical examination skills. These outpatient clinics serve a mix of patients with congenital and acquired heart problems, including those typically encountered in the office setting (evaluation of murmurs, chest pain, or syncope).

Cardiac Catheterization and Electrophysiology Rotation
During the cardiac catheterization and electrophysiology rotation, the fellow is responsible for caring for pediatric patients prior to, during, and after cardiac catheterization inclusive of those scheduled for electrophysiology studies and pacemaker placement. With the oversight of the catheterization faculty, the fellow creates a plan for the catheterization that includes the proposed sedation, venous and arterial access sites, the hemodynamic data to be collected, the appropriate angiography, and any proposed interventions.

This rotation allows fellows to participate in procedures in all pediatric cases and cases of adult congenital heart disease. Fellows are expected to review all patient data and indications, are responsible for obtaining consents, and are expected by the end of their fellowship to have the knowledge required to know appropriate indications, complications, interpretation of angiograms and hemodynamic data, post cath management, and patient disposition.

Adult Congenital Heart Disease Rotation
During the second year of fellowship, fellows will have a two-week rotation with the Mount Sinai Adult Congenital Heart Disease Team. The rotation will include seeing adult congenital heart disease outpatients and inpatient consults in addition to the ability to participate in cardiac catheterization and electrophysiology procedures performed on patients with adult congenital heart disease.

Ambulatory Clinic Rotation
Fellows will spend four weeks of their outpatient rotation during the second or third year covering a range of sub-specialty ambulatory clinics, including heart failure/transplant; bronchopulmonary dysplasia/pulmonary hypertension; cardiogenetics; Kawasaki’s disease; preventative cardiology; and exercise physiology. In addition, fellows have the opportunity to work with various faculty members during their office hours.

Research is an integral part of the Pediatric Cardiology Fellowship. Fellows are exposed to ongoing clinical and basic science research in the Division of Cardiology and the Department of Pediatrics through pediatric cardiology research conferences held every other month, and monthly Children's Health Research Center conferences. Fellows receive a total of 12 months of research time spread throughout the three years. Two months are assigned for the first year with the task of identifying a research focus and establishing a research project with the assistance of a research mentor. In your second year, you receive three months of research time, and in the third year, you receive seven months.

Fellows meet regularly with their research mentors, with regular evaluation by an assigned scholarly evaluation committee. Fellows present a research idea with complete background review and statistical design to the scholarly oversight committee (SOC) by the end of their first year. Thereafter, each fellow’s progress is monitored biannually by the SOC. By the third year, fellows are expected to submit at least one abstract of their work to an appropriate regional or national scientific meeting. The research manuscript is expected to be completed within four weeks of presenting the abstract. The expectation is that all fellows present at a national meeting and submit for a manuscript for publication in a peer-reviewed journal prior to graduation. Fellows are also required to take a scholarly activity and research course that incorporates didactics and lectures covering research methodology, grants, abstracts and manuscript writing, adult learning theory, and bioethics.